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      A Prospective Study to Investigate Predictors of Relapse among Patients with Opioid Use Disorder Treated with Methadone

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          Abstract

          INTRODUCTION

          Concomitant opioid abuse is a serious problem among patients receiving methadone maintenance treatment (MMT) for opioid use disorder. This is an exploratory study that aims to identify predictors of the length of time a patient receiving MMT for opioid use disorder remains abstinent (relapse-free).

          METHODS

          Data were collected from 250 MMT patients enrolled in addiction treatment clinics across Southern Ontario. The impact of certain clinical and socio-demographic factors on the outcome (time until opioid relapse) was determined using a Cox proportional hazard model.

          RESULTS

          History of injecting drug use behavior (hazard ratio (HR): 2.26, P = 0.042), illicit benzodiazepine consumption (HR: 1.07, P = 0.002), and the age of onset of opioid abuse (HR: 1.10, P < 0.0001) are important indicators of accelerated relapse among MMT patients. Conversely, current age is positively associated with duration of abstinence from illicit opioid use, serving as a protective factor against relapse (HR: 0.93, P = 0.003).

          CONCLUSION

          This study helps to identify patients at increased risk of relapse during MMT, allowing health care providers to target more aggressive adjunct therapies toward high-risk patients.

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          Most cited references61

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          The world health report 2002 - reducing risks, promoting healthy life.

          J Guilbert (2003)
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            Understanding survival analysis: Kaplan-Meier estimate

            Kaplan-Meier estimate is one of the best options to be used to measure the fraction of subjects living for a certain amount of time after treatment. In clinical trials or community trials, the effect of an intervention is assessed by measuring the number of subjects survived or saved after that intervention over a period of time. The time starting from a defined point to the occurrence of a given event, for example death is called as survival time and the analysis of group data as survival analysis. This can be affected by subjects under study that are uncooperative and refused to be remained in the study or when some of the subjects may not experience the event or death before the end of the study, although they would have experienced or died if observation continued, or we lose touch with them midway in the study. We label these situations as censored observations. The Kaplan-Meier estimate is the simplest way of computing the survival over time in spite of all these difficulties associated with subjects or situations. The survival curve can be created assuming various situations. It involves computing of probabilities of occurrence of event at a certain point of time and multiplying these successive probabilities by any earlier computed probabilities to get the final estimate. This can be calculated for two groups of subjects and also their statistical difference in the survivals. This can be used in Ayurveda research when they are comparing two drugs and looking for survival of subjects.
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              The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome.

              To develop a brief, multi-dimensional instrument for assessing treatment outcome for people with drug and/or alcohol problems. The Maudsley Addiction Profile (MAP) is the first instrument to be developed in the United Kingdom for this purpose. Field testing with quota-recruitment of problem drug users and problem alcohol users in treatment with researcher and clinician-administered test-retest interviews. Two community and two inpatient services at the Bethlem Royal and Maudsley Hospital, London. Subjects (160 drug users and 80 alcohol users) interviewed by eight interviews (four researchers and four clinicians), each of whom interviewed 30 subjects on two occasions. Sixty items across substance use, health risk, physical/psychological health and personal/social functioning domains. Average completion time of the MAP was 12 minutes. The questionnaire was acceptable to a majority of subjects and performed well with both researcher and clinician interviewers. Internal reliability and feasible concurrent validity assessments of the scales and items were highly satisfactory. Test-retest reliability was good, average intraclass correlation coefficients across eight substances were 0.94 and 0.81 across health risk, health problems, relationship conflict, employment and crime measures. The MAP can serve as a core research instrument with additional outcome measures added as required. The collection of a set of reliable quantitative measures of problems among drug and alcohol users by research or treatment personnel for outcome evaluation purposes need not be time-consuming.
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                Author and article information

                Journal
                Subst Abuse
                Subst Abuse
                Substance Abuse: Research and Treatment
                Substance Abuse: Research and Treatment
                Libertas Academica
                1178-2218
                2016
                10 April 2016
                : 10
                : 9-18
                Affiliations
                [1 ]Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
                [2 ]St. George’s University of London, London, United Kingdom.
                [3 ]Department of Clinical Epidemiology and Biostatistics, McMaster University, ON, Hamilton, Canada.
                [4 ]Canadian Addiction Treatment Centre, Richmond Hill, ON, Canada.
                [5 ]Department of Medicine, Hamilton General Hospital, Hamilton, ON, Canada.
                [6 ]Northern Ontario School of Medicine, Sudbury, ON, Canada.
                [7 ]Population Genomics Program, Chanchlani Research Center, McMaster University, Hamilton, ON, Canada.
                [8 ]Centre for Evaluation of Medicine, Hamilton, ON, Canada.
                [9 ]System Linked Research Unit, Hamilton, ON, Canada.
                [10 ]Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
                [11 ]Peter Boris Centre for Addictions Research, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada.
                Author notes
                Article
                sart-10-2016-009
                10.4137/SART.S37030
                4827793
                27103815
                b1240644-61ff-4eb8-897d-3f4bfa072501
                © 2016 the author(s), publisher and licensee Libertas Academica Ltd.

                This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 license.

                History
                : 28 October 2015
                : 05 January 2016
                : 07 January 2016
                Categories
                Original Research

                Health & Social care
                opioid use disorder,substance abuse,methadone,opioid substitution treatment,opioid relapse

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